The urgent need for new tools to prevent, diagnose and treat Ebola: what needs to happen Intro As of 7 November 2014, there have been nearly 14,000 reported cases of Ebola virus disease in West Africa and nearly 5,000 deaths. The number of new cases is thought to currently double every three weeks. The Ebola outbreak is already a major humanitarian crisis; it is likely to turn into a disaster on a much larger scale if our collective response is not radically improved. Frontline workers, including healthcare workers in Ebola treatment centres and other health facilities, are among the most vulnerable groups of people to potentially contract the disease. More than 230 healthcare workers in West Africa have died from Ebola since the start of the outbreak. If frontline workers continue to die from the disease, the response will be difficult to sustain at the current level, let alone grow to the scale needed. Over the last few months, MSF has voiced the need for more teams and infrastructure to control Ebola. If 70% of patients with Ebola were hospitalised in appropriate isolation rooms, then the epidemic would be reduced, some studies suggest. Recent announcements by countries, including the US, Cuba, and South Africa, among others, to deploy more human resources and build more treatment centres need to become a reality as soon as possible. More countries need to follow these examples. In addition, new tools to diagnose, treat and prevent Ebola are urgently needed. However, given that vaccines and treatments being developed for Ebola are still experimental – and as yet unapproved for use in humans – and given that the re-purposing of drugs approved for other diseases is still clinically untested, further clinical research to prove safety and efficacy is required. There is broad agreement that research on the new tools should be conducted as a matter of priority in the affected countries, provided all international ethical standards are followed, so that any benefits are immediately derived by those most directly affected by the epidemic. The deployment of additional resources in the affected countries is therefore also a prerequisite to conduct the clinical and operational research necessary in a manner that does not disrupt, but rather supports, existing treatment and control efforts.
New diagnostics for triage, new drugs to save more lives, and new vaccines to protect frontline workers and contain the outbreak Diagnosing Ebola virus disease currently requires a specific type of laboratory. A simple rapid diagnostic test that would not require complicated procedures or a lab infrastructure is urgently needed and would be extremely useful for triage. The test would help rule out Ebola virus disease in patients presenting with fever in health facilities and refer those suspected to be infected with Ebola to a specific Ebola treatment unit. The mean case fatality rate of Ebola virus disease in West Africa in the current outbreak is estimated to be close to 70%, though it can be significantly reduced if the patient is treated early in an appropriate treatment unit. In addition to the current treatment, one or several specific treatments against Ebola itself are urgently required that can bring down this unacceptable mortality rate. Ideally, the treatment course would be relatively short, the drug could be administered orally (as well as by parenteral route for patients who vomit) and would have few side effects. Most importantly, a vaccine that would give significant protection is considered a potential gamechanger to reduce transmission rates and potentially help end the outbreak in West Africa. Vaccine trials should provide experimental vaccines to frontline workers as a matter of priority. Once found effective, the vaccine should be seamlessly introduced on a larger scale in the general population in areas at risk. Ideally, only one shot would be needed to give protection, and the vaccine transported in o o a traditional cold chain (2 C – 8 C) rather than requiring the vaccine to be kept frozen. The potential ability of some drugs and vaccines to prevent disease in people exposed to the virus, notably caregivers of a sick patient and other frontline workers – drugs or vaccines that could be effective as post-exposure prophylaxis tools – could also be an important factor.